Student Conduct Incident Report Form

Use this form to report disruptive student behavior and/or request disciplinary action.

If the situation is an emergency and/or you have safety concerns, contact Security immediately at 224-3001 or 911 on a campus phone!

Student's Name

Student's ID#

Course and/or Incident Location

Date & Time Incident Occurred

Faculty or Staff Name

Contact No. and Email

Incident Description
Please describe the incident in detail below. Be as specific, clear, and objective as possible. “John shook his fist at me and said ‘you are a stupid loser’” is more helpful than “John was threatening and used aggressive language with me.” If possible, quote what was said verbatim, without regard to appropriateness of language. Include as much information as possible about witnesses or others involved, such as ID numbers or contact information.
You are not limited to the space below, and may respond by email or use another form, so long as all of the above is included.

Today's Date

Year/Month/DayHour:MinuteAM/PM

Additional Comments

These reports should be filed with the Dean of Students Office (SSC 202, 224-4342) as soon as possible after the incident. This form does not replace and may be in addition to a CNM Security Incident Report.